2.50
Hdl Handle:
http://hdl.handle.net/10755/157190
Category:
Abstract
Type:
Presentation
Title:
Chest Radiographs Post Chest Tube Removal in Children
Author(s):
Woodward, Cathy; Dowling, Donna; Gillespie, II, Gordon L.
Author Details:
Cathy Woodward, University of Texas Health Science Center San Antonio, San Antonio, Texas, USA, email: woodwardc@uthscsa.edu; Donna Dowling; Gordon L. Gillespie, II
Abstract:
PURPOSE: Chest tubes (CT) are placed at the time of surgery on children undergoing repair or palliation of congenital heart disease. Upon removal of the CT, a routine chest radiograph (CXR) is obtained to assess for the development of a pneumothorax, an infrequent but potentially serious complication of CT removal. The purpose of this study was to determine if signs and symptoms of pneumothorax are sufficient predictors of the need for CT reinsertion in children following CT removal after surgery. BACKGROUND: The practice of obtaining a routine CXR after CT removal is not supported by research. CXR's are a sensitive and specific way to determine the presence of a pneumothorax but unnecessary CXR's (a) expose children to low levels of ionizing radiation, (b) are costly, and (c) use unnecessary radiology and nursing resources. Adult studies have shown clinical evaluation to be a safe and effective method of determining which patients require CXR after CT removal. METHODS: The study used a prospective, descriptive comparative design. The setting was a 200 bed children's hospital in Texas. The sample included 60 children age six years or under who were post operative from repair or palliation of congenital heart disease. A cardiac and respiratory assessment was conducted by a nurse practitioner (NP) principal investigator immediately before and 2 hours after CT removal. The NP made a decision based on her assessment whether a CXR was warranted and the routine CXR was completed. The CXR was read by a pediatric intensivist who was blinded to the findings of the NP. RESULTS: No subjects developed clinical signs and symptoms of respiratory distress after removal of their CT and no CXR's were recommended based on assessment by the NP investigator. One subject developed a small, clinically insignificant pneumothorax after CT removal which did not require any intervention. There were no significant pneumothoraces. The risk of developing a significant pneumothorax for this study was less than 5%. CONCLUSIONS: The absence of clinically significant pneumothoraces post chest tube removal in this sample may not represent other populations of children with CT's placed for reasons. The type of CT placed and the method of removal used at the study hospital may have influenced the findings. Based on the exact binomial distribution with 60 subjects, none with clinically significant pneumothoraces, the risk of developing a pneumothorax after CT removal may be low enough to consider not obtaining a CXR.
Repository Posting Date:
26-Oct-2011
Date of Publication:
26-Oct-2011
Citation:
2009 National Teaching Institute Research Abstracts. American Journal of Critical Care, 18(3), e1-e17.
Conference Date:
2009
Conference Name:
National Teaching Institute and Critical Care Exposition
Conference Host:
American Association of Critical-Care Nurses
Conference Location:
New Orleans, Louisiana, USA
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_GB
dc.typePresentationen_GB
dc.titleChest Radiographs Post Chest Tube Removal in Childrenen_GB
dc.contributor.authorWoodward, Cathyen_GB
dc.contributor.authorDowling, Donnaen_GB
dc.contributor.authorGillespie, II, Gordon L.en_GB
dc.author.detailsCathy Woodward, University of Texas Health Science Center San Antonio, San Antonio, Texas, USA, email: woodwardc@uthscsa.edu; Donna Dowling; Gordon L. Gillespie, IIen_GB
dc.identifier.urihttp://hdl.handle.net/10755/157190-
dc.description.abstractPURPOSE: Chest tubes (CT) are placed at the time of surgery on children undergoing repair or palliation of congenital heart disease. Upon removal of the CT, a routine chest radiograph (CXR) is obtained to assess for the development of a pneumothorax, an infrequent but potentially serious complication of CT removal. The purpose of this study was to determine if signs and symptoms of pneumothorax are sufficient predictors of the need for CT reinsertion in children following CT removal after surgery. BACKGROUND: The practice of obtaining a routine CXR after CT removal is not supported by research. CXR's are a sensitive and specific way to determine the presence of a pneumothorax but unnecessary CXR's (a) expose children to low levels of ionizing radiation, (b) are costly, and (c) use unnecessary radiology and nursing resources. Adult studies have shown clinical evaluation to be a safe and effective method of determining which patients require CXR after CT removal. METHODS: The study used a prospective, descriptive comparative design. The setting was a 200 bed children's hospital in Texas. The sample included 60 children age six years or under who were post operative from repair or palliation of congenital heart disease. A cardiac and respiratory assessment was conducted by a nurse practitioner (NP) principal investigator immediately before and 2 hours after CT removal. The NP made a decision based on her assessment whether a CXR was warranted and the routine CXR was completed. The CXR was read by a pediatric intensivist who was blinded to the findings of the NP. RESULTS: No subjects developed clinical signs and symptoms of respiratory distress after removal of their CT and no CXR's were recommended based on assessment by the NP investigator. One subject developed a small, clinically insignificant pneumothorax after CT removal which did not require any intervention. There were no significant pneumothoraces. The risk of developing a significant pneumothorax for this study was less than 5%. CONCLUSIONS: The absence of clinically significant pneumothoraces post chest tube removal in this sample may not represent other populations of children with CT's placed for reasons. The type of CT placed and the method of removal used at the study hospital may have influenced the findings. Based on the exact binomial distribution with 60 subjects, none with clinically significant pneumothoraces, the risk of developing a pneumothorax after CT removal may be low enough to consider not obtaining a CXR.en_GB
dc.date.available2011-10-26T19:30:09Z-
dc.date.issued2011-10-26en_GB
dc.date.accessioned2011-10-26T19:30:09Z-
dc.identifier.citation2009 National Teaching Institute Research Abstracts. American Journal of Critical Care, 18(3), e1-e17.en_GB
dc.conference.date2009en_GB
dc.conference.nameNational Teaching Institute and Critical Care Expositionen_GB
dc.conference.hostAmerican Association of Critical-Care Nursesen_GB
dc.conference.locationNew Orleans, Louisiana, USAen_GB
dc.identifier.citation2009 National Teaching Institute Research Abstracts. American Journal of Critical Care, 18(3), e1-e17.en_GB
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.-
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